Table of ContentsView AllTable of ContentsSymptomsWho Is at RiskDrugs Causing Rebound HeadacheTreatmentPreventionWhen to Seek Care
Table of ContentsView All
View All
Table of Contents
Symptoms
Who Is at Risk
Drugs Causing Rebound Headache
Treatment
Prevention
When to Seek Care
This article explores how rebound headaches manifest and who is most at risk for having them. The treatment and prevention of this disabling yet often under-recognized headache disorder will also be reviewed.
Ekaterina Goncharova / Getty Images
What Does a Rebound Headache Feel Like?
Rebound headaches occur 15 or more days per month and only develop in a person with a preexisting primary headache disorder.
What Is a Primary Headache Disorder?Primary headache disorders exist on their own, with common ones being migraines, tension-type headaches, andcluster headaches.
What Is a Primary Headache Disorder?
Primary headache disorders exist on their own, with common ones being migraines, tension-type headaches, andcluster headaches.
Rebound headaches vary considerably in severity, location, and quality (how they feel). However, they tend to be worse in the morning upon awakening and occur daily, nearly daily, or, in some cases,continuously.
They are also associated with an increased sensitivity to pain in other areas of the body, namely the neck, shoulders, and back.
Who Gets Rebound Headaches?
Factors associated with an increased risk of developing rebound headaches include:
Interestingly, genetic factors may also affect the likelihood of developing rebound headaches.
Limited scientific evidence suggests thatpolymorphisms(slight changes in theDNAsequence of a gene) of thedopaminegene system may affect a person’s vulnerability to rebound headaches.
What Is Dopamine?Dopamine is a brain chemical associated with pleasure, motivation, decision-making, dependence, and addiction.
What Is Dopamine?
Dopamine is a brain chemical associated with pleasure, motivation, decision-making, dependence, and addiction.
Along the same lines, brain imaging studies have found structural changes within dopamine pathways—the reward system—in people with rebound headaches.
Which Drugs Cause Rebound Headaches?
Most acute headache medications can cause rebound headaches.While studies vary slightly, the consensus is that the highest risk for rebound headaches is associated with opioids and butalbital-containing combination analgesics.
Opioidsandbutalbital-containing combination analgesicscan cause rebound headaches with 10 or more days of usage per month.
Examples of these drugs include:
Side Effects and Risks of Taking Oxycodone for Headaches
Withtriptans,ergot alkaloids, andcombination analgesics, such as Excedrin Migraine (a combination of acetaminophen, aspirin, and caffeine), medication overuse is defined as taking the drug on 10 or more days per month.
What Are Triptans?Triptans, like Imitrex (sumatriptan), are abortive migraine medications, meaning they stop a migraine that has started. They are available in several formulations, including pills, dissolvable tablets, nasal sprays/powders, and shots.
What Are Triptans?
Triptans, like Imitrex (sumatriptan), are abortive migraine medications, meaning they stop a migraine that has started. They are available in several formulations, including pills, dissolvable tablets, nasal sprays/powders, and shots.
The lowest risk for rebound headaches appears to occur withaspirin,Tylenol(acetaminophen), andnonsteroidal anti-inflammatory drugs(NSAIDs), such as Advil or Motrin (ibuprofen) and Aleve (naproxen sodium).Progression to rebound headaches can develop in people taking these medications for 15 or more days per month.
Lastly, there are newer headache (particularly migraine) drugs, where the risk for rebound headaches remains largely unknown. That said, early thoughts that they pose a lower risk for developing rebound headaches based on their mode of action are promising.
These newer migraine drugs include:
Migraine Treatments: Everything You Need to Know
How a Rebound Headache Is Treated
There are three key steps to treating rebound headache.
Medication Discontinuation/Reduction
The first and crucial step is stopping or significantly decreasing the dose of the overused headache medication. Depending on the drug, this process of discontinuation or reduction varies.
For example, if the offending medication is an NSAID or triptan, it can usually be stopped or weaned down immediately at home under the guidance of a healthcare provider.
Excedrin Migraine or other OTC headache analgesics that contain caffeine require a slow taper at home, as they can cause unpleasantcaffeine withdrawalsymptoms (e.g., anxiety, fast heart rate, and nausea).
Those who are taking frequent and/or high doses of opioids or butalbital combination drugs require hospitalization when tapering down because thewithdrawal symptomsfrom taking these drugs can be severe, if not potentially life-threatening.
Whether discontinuing at home or in a hospital setting, note that a person’s headaches will temporarily worsen.
During the headache medication withdrawal period—which lasts around 10 days and sometimes up to three weeks—a healthcare provider may recommend what are considered rescue medications, such asprednisone(a steroid), to help relieve headaches.
The second step for treating rebound headaches is to start a preventive medication around the same time or after discontinuing/reducing the overused medication.
The type of preventive therapy chosen depends on the underlying primary headache disorder.
Examples ofpreventive migraine drugsinclude:
Likewise, preventive medications for tension-type headaches include:
Incorporating Complementary TherapiesBesides taking a preventive headache medication, a provider may recommend a non-drug therapy, likebiofeedback, to further minimize rebound headaches and medication use.
Incorporating Complementary Therapies
Besides taking a preventive headache medication, a provider may recommend a non-drug therapy, likebiofeedback, to further minimize rebound headaches and medication use.
During and after discontinuing or significantly reducing the offending headache medication, close follow-up with a healthcare provider is vital to ensure adherence to the new treatment plan.
Starting a calendar or journal to record the number of headache days and medication dosage is a valuable tool to help keep a person on track and prevent relapse.
Can a Rebound Headache Be Prevented?
Preventing rebound headaches and the debilitating cycle of pain and medication overuse they create is essential, especially considering how grueling and time-consuming the discontinuation process can be.
If you experience headaches, talk with a healthcare provider about strategies to prevent medication overuse, such as taking a highly effective medication at an optimal dose as soon as possible at the start of a headache.
More specifically, limit your use of triptans, ergot alkaloids, and combination analgesics to less than 10 days per month. Aspirin, Tylenol, and NSAIDs should be limited to less than 15 days per month.
Avoid opioids and butalbital, if possible, and start a preventive headache medication if you are experiencing eight or more headaches days per month.
When to Contact a Healthcare Provider
If you notice an escalation in your headache medication use, promptly schedule an appointment with a healthcare provider orheadache specialist(neurologist).
Also, see a provider if your headaches are changing in pattern, becoming more severe, or if the following scenarios pertain to you:
When Should You Worry About a Headache?
Summary
Rebound headaches, known formally as medication-overuse headaches, occur as a consequence of excessive use of acute headache medication over a three-month timeframe. Factors like a history of smoking, anxiety, substance abuse, and high caffeine intake can increase a person’s risk of developing this disabling headache disorder.
Rebound headaches occur 15 or more days per month and only develop in a person with a pre-existing primary headache disorder, usually migraine or tension-type headaches.
Treating rebound headaches entails three steps—stopping the offending medication, starting a headache preventive medication, and following closely with a healthcare provider to prevent relapse.
15 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Ashina S, Mitsikostas DD, Lee MJ, et al.Tension-type headache.Nat Rev Dis Primers. 2021;7(1):24. doi:10.1038/s41572-021-00257-2Headache Classification Committee of the International Headache Society (IHS).The International Classification of Headache Disorders, 3rd edition (beta version).Cephalalgia. 2013;33(9):629-808. doi:10.1177/0333102413485658International Headache Society.Medication-overuse headache awareness campaign.Wakerley BR.Medication-overuse headache.Pract Neurol.2019;19(5):399-403. doi:10.1136/practneurol-2018-002048Kristoffersen ES, Lundqvist C.Medication-overuse headache: epidemiology, diagnosis and treatment.Ther Adv Drug Saf. 2014;5(2):87-99. doi:10.1177/2042098614522683Zduńska A, Cegielska J, Zduński S, Domitrz I.Caffeine for Headaches: Helpful or Harmful? A Brief Review of the Literature.Nutrients. 2023 Jul 17;15(14):3170. doi:10.3390/nu15143170Cargnin S, Viana M, Sances G, Tassorelli C, Terrazzino S.A systematic review and critical appraisal of gene polymorphism association studies in medication-overuse headache.Cephalalgia. 2018;38(7):1361-1373. doi:10.1177/0333102417728244Lai TH, Wang SJ.Neuroimaging findings in patients with medication overuse headache.Curr Pain Headache Rep. 2018;22(1):1. doi:10.1007/s11916-018-0661-0van Hoogstraten WS, MaassenVanDenBrink A.The need for new acutely acting antimigraine drugs: moving safely outside acute medication overuse.J Headache Pain. 2019;20(1):54. doi:10.1186/s10194-019-1007-yMinen MT, Tanev K, Friedman BW.Evaluation and treatment of migraine in the emergency department: a review.Headache. 2014;54(7):1131-45. doi:10.1111/head.12399Lipton RB, Serrano D, Nicholson RA, Buse DC, Runken MC, Reed ML.Impact of NSAID and Triptan use on developing chronic migraine: results from the American Migraine Prevalence and Prevention (AMPP) study.Headache. 2013 Nov-Dec;53(10):1548-63. doi:10.1111/head.12201Ha H, Gonzalez A.Migraine headache prophylaxis.Am Fam Physician. 2019;99(1):17-24.Food and Drug Administration.New drug class employs novel mechanism for migraine treatment and prevention.Rausa M, Palomba D, Cevoli S, et al.Biofeedback in the prophylactic treatment of medication overuse headache: a pilot randomized controlled trial.J Headache Pain. 2016;17(1):87. doi:10.1186/s10194-016-0679-9Phu Do T, Remmers A, Schytz HW et al.Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list.Neurology.2019;92(3):134-144. doi:10.1212/WNL.0000000000006697
15 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Ashina S, Mitsikostas DD, Lee MJ, et al.Tension-type headache.Nat Rev Dis Primers. 2021;7(1):24. doi:10.1038/s41572-021-00257-2Headache Classification Committee of the International Headache Society (IHS).The International Classification of Headache Disorders, 3rd edition (beta version).Cephalalgia. 2013;33(9):629-808. doi:10.1177/0333102413485658International Headache Society.Medication-overuse headache awareness campaign.Wakerley BR.Medication-overuse headache.Pract Neurol.2019;19(5):399-403. doi:10.1136/practneurol-2018-002048Kristoffersen ES, Lundqvist C.Medication-overuse headache: epidemiology, diagnosis and treatment.Ther Adv Drug Saf. 2014;5(2):87-99. doi:10.1177/2042098614522683Zduńska A, Cegielska J, Zduński S, Domitrz I.Caffeine for Headaches: Helpful or Harmful? A Brief Review of the Literature.Nutrients. 2023 Jul 17;15(14):3170. doi:10.3390/nu15143170Cargnin S, Viana M, Sances G, Tassorelli C, Terrazzino S.A systematic review and critical appraisal of gene polymorphism association studies in medication-overuse headache.Cephalalgia. 2018;38(7):1361-1373. doi:10.1177/0333102417728244Lai TH, Wang SJ.Neuroimaging findings in patients with medication overuse headache.Curr Pain Headache Rep. 2018;22(1):1. doi:10.1007/s11916-018-0661-0van Hoogstraten WS, MaassenVanDenBrink A.The need for new acutely acting antimigraine drugs: moving safely outside acute medication overuse.J Headache Pain. 2019;20(1):54. doi:10.1186/s10194-019-1007-yMinen MT, Tanev K, Friedman BW.Evaluation and treatment of migraine in the emergency department: a review.Headache. 2014;54(7):1131-45. doi:10.1111/head.12399Lipton RB, Serrano D, Nicholson RA, Buse DC, Runken MC, Reed ML.Impact of NSAID and Triptan use on developing chronic migraine: results from the American Migraine Prevalence and Prevention (AMPP) study.Headache. 2013 Nov-Dec;53(10):1548-63. doi:10.1111/head.12201Ha H, Gonzalez A.Migraine headache prophylaxis.Am Fam Physician. 2019;99(1):17-24.Food and Drug Administration.New drug class employs novel mechanism for migraine treatment and prevention.Rausa M, Palomba D, Cevoli S, et al.Biofeedback in the prophylactic treatment of medication overuse headache: a pilot randomized controlled trial.J Headache Pain. 2016;17(1):87. doi:10.1186/s10194-016-0679-9Phu Do T, Remmers A, Schytz HW et al.Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list.Neurology.2019;92(3):134-144. doi:10.1212/WNL.0000000000006697
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Ashina S, Mitsikostas DD, Lee MJ, et al.Tension-type headache.Nat Rev Dis Primers. 2021;7(1):24. doi:10.1038/s41572-021-00257-2Headache Classification Committee of the International Headache Society (IHS).The International Classification of Headache Disorders, 3rd edition (beta version).Cephalalgia. 2013;33(9):629-808. doi:10.1177/0333102413485658International Headache Society.Medication-overuse headache awareness campaign.Wakerley BR.Medication-overuse headache.Pract Neurol.2019;19(5):399-403. doi:10.1136/practneurol-2018-002048Kristoffersen ES, Lundqvist C.Medication-overuse headache: epidemiology, diagnosis and treatment.Ther Adv Drug Saf. 2014;5(2):87-99. doi:10.1177/2042098614522683Zduńska A, Cegielska J, Zduński S, Domitrz I.Caffeine for Headaches: Helpful or Harmful? A Brief Review of the Literature.Nutrients. 2023 Jul 17;15(14):3170. doi:10.3390/nu15143170Cargnin S, Viana M, Sances G, Tassorelli C, Terrazzino S.A systematic review and critical appraisal of gene polymorphism association studies in medication-overuse headache.Cephalalgia. 2018;38(7):1361-1373. doi:10.1177/0333102417728244Lai TH, Wang SJ.Neuroimaging findings in patients with medication overuse headache.Curr Pain Headache Rep. 2018;22(1):1. doi:10.1007/s11916-018-0661-0van Hoogstraten WS, MaassenVanDenBrink A.The need for new acutely acting antimigraine drugs: moving safely outside acute medication overuse.J Headache Pain. 2019;20(1):54. doi:10.1186/s10194-019-1007-yMinen MT, Tanev K, Friedman BW.Evaluation and treatment of migraine in the emergency department: a review.Headache. 2014;54(7):1131-45. doi:10.1111/head.12399Lipton RB, Serrano D, Nicholson RA, Buse DC, Runken MC, Reed ML.Impact of NSAID and Triptan use on developing chronic migraine: results from the American Migraine Prevalence and Prevention (AMPP) study.Headache. 2013 Nov-Dec;53(10):1548-63. doi:10.1111/head.12201Ha H, Gonzalez A.Migraine headache prophylaxis.Am Fam Physician. 2019;99(1):17-24.Food and Drug Administration.New drug class employs novel mechanism for migraine treatment and prevention.Rausa M, Palomba D, Cevoli S, et al.Biofeedback in the prophylactic treatment of medication overuse headache: a pilot randomized controlled trial.J Headache Pain. 2016;17(1):87. doi:10.1186/s10194-016-0679-9Phu Do T, Remmers A, Schytz HW et al.Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list.Neurology.2019;92(3):134-144. doi:10.1212/WNL.0000000000006697
Ashina S, Mitsikostas DD, Lee MJ, et al.Tension-type headache.Nat Rev Dis Primers. 2021;7(1):24. doi:10.1038/s41572-021-00257-2
Headache Classification Committee of the International Headache Society (IHS).The International Classification of Headache Disorders, 3rd edition (beta version).Cephalalgia. 2013;33(9):629-808. doi:10.1177/0333102413485658
International Headache Society.Medication-overuse headache awareness campaign.
Wakerley BR.Medication-overuse headache.Pract Neurol.2019;19(5):399-403. doi:10.1136/practneurol-2018-002048
Kristoffersen ES, Lundqvist C.Medication-overuse headache: epidemiology, diagnosis and treatment.Ther Adv Drug Saf. 2014;5(2):87-99. doi:10.1177/2042098614522683
Zduńska A, Cegielska J, Zduński S, Domitrz I.Caffeine for Headaches: Helpful or Harmful? A Brief Review of the Literature.Nutrients. 2023 Jul 17;15(14):3170. doi:10.3390/nu15143170
Cargnin S, Viana M, Sances G, Tassorelli C, Terrazzino S.A systematic review and critical appraisal of gene polymorphism association studies in medication-overuse headache.Cephalalgia. 2018;38(7):1361-1373. doi:10.1177/0333102417728244
Lai TH, Wang SJ.Neuroimaging findings in patients with medication overuse headache.Curr Pain Headache Rep. 2018;22(1):1. doi:10.1007/s11916-018-0661-0
van Hoogstraten WS, MaassenVanDenBrink A.The need for new acutely acting antimigraine drugs: moving safely outside acute medication overuse.J Headache Pain. 2019;20(1):54. doi:10.1186/s10194-019-1007-y
Minen MT, Tanev K, Friedman BW.Evaluation and treatment of migraine in the emergency department: a review.Headache. 2014;54(7):1131-45. doi:10.1111/head.12399
Lipton RB, Serrano D, Nicholson RA, Buse DC, Runken MC, Reed ML.Impact of NSAID and Triptan use on developing chronic migraine: results from the American Migraine Prevalence and Prevention (AMPP) study.Headache. 2013 Nov-Dec;53(10):1548-63. doi:10.1111/head.12201
Ha H, Gonzalez A.Migraine headache prophylaxis.Am Fam Physician. 2019;99(1):17-24.
Food and Drug Administration.New drug class employs novel mechanism for migraine treatment and prevention.
Rausa M, Palomba D, Cevoli S, et al.Biofeedback in the prophylactic treatment of medication overuse headache: a pilot randomized controlled trial.J Headache Pain. 2016;17(1):87. doi:10.1186/s10194-016-0679-9
Phu Do T, Remmers A, Schytz HW et al.Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list.Neurology.2019;92(3):134-144. doi:10.1212/WNL.0000000000006697
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